Health Information

Guides you through decision to have weight-loss surgery. Covers health problems like high blood pressure and type 2 diabetes that can be caused by obesity. Lists reasons for and against surgery. Includes an interactive tool to help you make your decision.

Guides you through decision to have weight-loss surgery. Covers health problems like high blood pressure and type 2 diabetes that can be caused by obesity. Lists reasons for and against surgery. Includes an interactive tool to help you make your decision.

Obesity: Should I Have Weight-Loss Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

You are an adult with a BMI of 35 or higher and
you also have another health problem related to your weight, such as
type 2 diabetes or
arthritis.

In adolescents, as in adults, these surgical procedures are not typically recommended unless the BMI is over 40 or the child has severe health problems and a BMI over 35. Younger children may not be considered for surgery unless their BMI is even higher. Your child's doctor can help you decide if the health risks of severe obesity outweigh the risks of surgery. Surgery is considered only after changes have been made to increase physical activity, eat the right range of calories, and possibly use medicine for weight loss, under the direction of a doctor.

Most people lose at least a third of their
extra weight after surgery. Some people lose almost all of their extra
weight. Weight loss varies with the type of surgery and how closely people follow the recommendations for lifestyle changes, check-up appointments, and counseling as instructed by the doctor.

Weight-loss surgery is not cosmetic surgery. It will not remove fatty tissue. And after a lot of weight loss, you may have excess skin. Some people choose to have more surgery to remove skin from the belly, thighs, upper arms, or breasts.

After surgery, you will need to make big, lifelong changes
in how you eat—including smaller portions and different foods. Regular exercise is also important for losing weight and keeping it off. Some people gain
weight again after a few years because they can't make these permanent
changes.

Weight-loss surgery has risks, including a risk of death.
You need to compare the risks of being very overweight with the risks of
surgery.

The restrictive procedures make the stomach smaller (restricting the size and the amount of food that can be in the stomach). Examples of restrictive surgeries include:

Adjustable gastric banding. A band is placed around the upper part of the stomach, creating a pouch. The band is adjustable, so the size of the opening between the pouch and the stomach can be adjusted.

Gastric sleeve. More than half of your stomach is removed, leaving a thin sleeve, or tube, that is about the size of a banana. Because part of your stomach has been removed, this is not reversible.
Sometimes this surgery is the first stage of another operation. For example, if you need to lose a lot of weight before you have duodenal switch surgery, gastric sleeve surgery may help you.

In the malabsorptive procedures, part of the intestine is bypassed. Since nutrients are normally absorbed in the intestine, bypassing a part of it reduces how much it can absorb, which can cause weight loss.

Combination procedures are both restrictive and malabsorptive. Examples include:

Roux-en-Y gastric bypass. A small part of the stomach is used to create a new stomach pouch, roughly the size of an egg. The smaller stomach is connected to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. This reduces the amount of food you can eat at one time. Bypassing part of the intestine reduces how much food and nutrients are absorbed. This leads to weight loss.

Biliopancreatic diversion. A biliopancreatic diversion changes the normal process of digestion by making the stomach smaller. It allows food to bypass part of the small intestine so that you absorb fewer calories. There are two biliopancreatic diversion surgeries:

In a biliopancreatic diversion, a portion of the stomach is removed. The remaining portion of the stomach is connected to the lower portion of the small intestine. The food you eat then bypasses much of the small intestine, which results in fewer calories absorbed and weight loss.

In a biliopancreatic diversion with duodenal switch, a portion of the stomach is removed but the pylorus remains intact. The pylorus controls food drainage from the stomach. The pylorus is connected to a lower segment of the intestine. The duodenum is connected to the lower part of the small intestine. The food you eat then bypasses much of the small intestine, which results in fewer calories absorbed and weight loss.

Most people who have weight-loss surgery are between 18
and 65 years old. But the surgery is often done on people older than 65. And it
is sometimes done on people younger than 18.

Two ways surgery is done

Open surgery. The
surgeon makes a large cut in the belly.

Laparoscopic surgery.
The
surgeon makes several small cuts and uses small tools and a camera to guide the
surgery. You recover sooner and are less likely to have pain or problems after
surgery.

After
surgery, you'll need to make big, permanent changes in how you eat:

Tiny meals. You can
eat only a few ounces of food at a time. Your new stomach will only hold a tiny
amount of food.

Eat slowly. You must eat
very slowly and chew your food to mush. Otherwise, you may vomit often and have
pain.

No liquids with meals. You won't be
able to drink for 30 minutes before you eat, during your meal, and for 30
minutes after you eat. There won't be room in your stomach for both drinks and
solid food. You'll also want to be careful about drinking alcohol. You may become intoxicated much more quickly, and alcohol can also cause ulcers in your stomach and/or intestines.

Vitamins. You will
need to take vitamins and supplements, because you won't get enough nutrition from the small amounts of food you eat. If you have surgical changes to your intestines, your body won't be absorbing all the nutrition from the food.

Avoid fatty, sugary foods. You may have to avoid foods that contain simple
sugars—like candy, juices, ice cream, condiments, and soft drinks. Simple
sugars may cause a problem called dumping syndrome. This happens because food
moves too quickly through the stomach and intestines. It can cause shaking,
sweating, dizziness, rapid heart rate, and often severe diarrhea. It can also cause belly pain, cramping, and nausea. Dumping syndrome may occur after gastric bypass surgery but is unlikely after gastric band or gastric sleeve surgery.

There can be a leak from the stomach into the
belly area, which can cause an infection called
peritonitis.

After adjustable gastric banding

You are more likely to need another surgery to fix complications than you would be after gastric bypass. For example, some patients need a second operation because the band slips or it works its way from the outside of the
stomach to the inside. This complication is called an erosion.

You won't lose weight as fast as you
would with gastric bypass.

Surgery has another risk: even though it helps you
lose weight, after a few years you may gain the weight back if you don't follow the changes in your eating and lifestyle.

Weight-loss surgery is not cosmetic surgery. It will not remove fatty tissue. And after a lot of weight loss, you may have excess skin. Some people choose to have more surgery to remove skin from the belly, thighs, upper arms, or breasts.

Personal stories about having surgery for obesity

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

Weight never
used to be a problem for me. But then I had some problems in life and started
gaining weight. I tried to lose weight but my problems kept getting in the way.
I looked into surgery, but it seemed like a last resort. Instead, I'm working
through my problems and feel I can get back to my old weight through less
drastic means.

Charlene, age 52

I'm pretty young, but my doctor is worried
about my weight problem. I guess my BMI and waist size put me at high risk for
complications, especially type 2 diabetes. I've tried diet and medicines, but have
not had any luck. My doctor is now talking to me about a gastric bypass, and
I'm going to give it a try. I need to lose the weight, and feel I can live with
the side effects and risks of surgery.

Mike, age 35

I know I'm
obese and that I'm at risk for health problems. But to me, the risk of surgery
and side effects are as bad as being obese, especially at my age. I might try
diet or medicine again, but who knows? I'm happy with who I am and lead a
good life. Surgery might make it worse. It's not for me.

Melissa, age 60

I'm tired of
being fat. I've had a weight problem since I was a kid and want something
different. Diets, drugs, exercise—I've tried them all. I've been talking to my
doctor about surgery. We both feel that reducing my risk of heart problems,
plus feeling better about myself, is worth the risks of surgery. The surgery
sounds effective, and I feel if I can get started, I'll do fine on my own.

Frank, age
48

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose weight-loss surgery

Reasons not to choose weight-loss surgery

I have tried diet, exercise, and medicine, and they haven't worked.

I want to keep trying diet, exercise, and medicine to lose weight.

More important

Equally important

More important

My weight bothers me so much that I am willing to have surgery, even though there are risks involved.

My weight doesn't bother me enough to take on the risks of surgery.

More important

Equally important

More important

I feel confident that I can make major diet and exercise changes after surgery.

I'm not sure I can handle the diet and exercise changes I'll need to make after surgery.

More important

Equally important

More important

I'm not worried about paying for this surgery.

I don't think I can afford to pay for this surgery.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

After weight-loss surgery, I will be able to eat normal amounts of food.

TrueSorry, but that's wrong. Surgery will make your stomach much smaller than normal, so you will need to eat very small amounts of food and pay very close attention to getting the right amounts of vitamins and minerals.

FalseCorrect. Surgery will make your stomach much smaller than normal, so you will need to eat very small amounts of food and pay very close attention to getting the right amounts of vitamins and minerals.

I'm not sureIt may help to go back and read "Get the Facts." You will need to eat very small amounts of food after surgery.

2.

Having weight-loss surgery can cause problems, but my being very overweight can also cause health problems.

TrueThat's right. Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and type 2 diabetes. You need to compare the risks of being obese with the risks of surgery.

FalseSorry, that's wrong. Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and type 2 diabetes. You need to compare the different risks.

I'm not sureIt may help to go back and read "Get the Facts." Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and type 2 diabetes. You need to compare the risks.

3.

Surgery may be an option for me because my BMI is higher than 40.

TrueYou're right. Surgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.

FalseSurgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.

I'm not sureIt may help to go back and read "Get the Facts." Surgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Obesity: Should I Have Weight-Loss Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have weight-loss surgery.

Do not
have weight-loss surgery.

Key points to remember

Being very overweight makes you more likely
to have serious health problems, such as
heart disease and
type 2 diabetes.

Surgery may be an option
if you haven't been able to lose weight with diet and exercise and if:

You are an adult with a BMI of 35 or higher and
you also have another health problem related to your weight, such as
type 2 diabetes or
arthritis.

In adolescents, as in adults, these surgical procedures are not typically recommended unless the BMI is over 40 or the child has severe health problems and a BMI over 35. Younger children may not be considered for surgery unless their BMI is even higher. Your child's doctor can help you decide if the health risks of severe obesity outweigh the risks of surgery. Surgery is considered only after changes have been made to increase physical activity, eat the right range of calories, and possibly use medicine for weight loss, under the direction of a doctor.

Most people lose at least a third of their
extra weight after surgery. Some people lose almost all of their extra
weight. Weight loss varies with the type of surgery and how closely people follow the recommendations for lifestyle changes, check-up appointments, and counseling as instructed by the doctor.

Weight-loss surgery is not cosmetic surgery. It will not remove fatty tissue. And after a lot of weight loss, you may have excess skin. Some people choose to have more surgery to remove skin from the belly, thighs, upper arms, or breasts.

After surgery, you will need to make big, lifelong changes
in how you eat—including smaller portions and different foods. Regular exercise is also important for losing weight and keeping it off. Some people gain
weight again after a few years because they can't make these permanent
changes.

Weight-loss surgery has risks, including a risk of death.
You need to compare the risks of being very overweight with the risks of
surgery.

What is surgery for obesity?

The restrictive procedures make the stomach smaller (restricting the size and the amount of food that can be in the stomach). Examples of restrictive surgeries include:

Adjustable gastric banding . A band is placed around the upper part of the stomach, creating a pouch. The band is adjustable, so the size of the opening between the pouch and the stomach can be adjusted.

Gastric sleeve. More than half of your stomach is removed, leaving a thin sleeve, or tube, that is about the size of a banana. Because part of your stomach has been removed, this is not reversible.
Sometimes this surgery is the first stage of another operation. For example, if you need to lose a lot of weight before you have duodenal switch surgery, gastric sleeve surgery may help you.

In the malabsorptive procedures, part of the intestine is bypassed. Since nutrients are normally absorbed in the intestine, bypassing a part of it reduces how much it can absorb, which can cause weight loss.

Combination procedures are both restrictive and malabsorptive. Examples include:

Roux-en-Y gastric bypass . A small part of the stomach is used to create a new stomach pouch, roughly the size of an egg. The smaller stomach is connected to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. This reduces the amount of food you can eat at one time. Bypassing part of the intestine reduces how much food and nutrients are absorbed. This leads to weight loss.

Biliopancreatic diversion. A biliopancreatic diversion changes the normal process of digestion by making the stomach smaller. It allows food to bypass part of the small intestine so that you absorb fewer calories. There are two biliopancreatic diversion surgeries:

In a biliopancreatic diversion , a portion of the stomach is removed. The remaining portion of the stomach is connected to the lower portion of the small intestine. The food you eat then bypasses much of the small intestine, which results in fewer calories absorbed and weight loss.

In a biliopancreatic diversion with duodenal switch , a portion of the stomach is removed but the pylorus remains intact. The pylorus controls food drainage from the stomach. The pylorus is connected to a lower segment of the intestine. The duodenum is connected to the lower part of the small intestine. The food you eat then bypasses much of the small intestine, which results in fewer calories absorbed and weight loss.

Most people who have weight-loss surgery are between 18
and 65 years old. But the surgery is often done on people older than 65. And it
is sometimes done on people younger than 18.

Two ways surgery is done

Open surgery. The
surgeon makes a large cut in the belly.

Laparoscopic surgery.
The
surgeon makes several small cuts and uses small tools and a camera to guide the
surgery. You recover sooner and are less likely to have pain or problems after
surgery.

How will surgery affect what you eat?

After
surgery, you'll need to make big, permanent changes in how you eat:

Tiny meals. You can
eat only a few ounces of food at a time. Your new stomach will only hold a tiny
amount of food.

Eat slowly. You must eat
very slowly and chew your food to mush. Otherwise, you may vomit often and have
pain.

No liquids with meals. You won't be
able to drink for 30 minutes before you eat, during your meal, and for 30
minutes after you eat. There won't be room in your stomach for both drinks and
solid food. You'll also want to be careful about drinking alcohol. You may become intoxicated much more quickly, and alcohol can also cause ulcers in your stomach and/or intestines.

Vitamins. You will
need to take vitamins and supplements, because you won't get enough nutrition from the small amounts of food you eat. If you have surgical changes to your intestines, your body won't be absorbing all the nutrition from the food.

Avoid fatty, sugary foods. You may have to avoid foods that contain simple
sugars—like candy, juices, ice cream, condiments, and soft drinks. Simple
sugars may cause a problem called dumping syndrome. This happens because food
moves too quickly through the stomach and intestines. It can cause shaking,
sweating, dizziness, rapid heart rate, and often severe diarrhea. It can also cause belly pain, cramping, and nausea. Dumping syndrome may occur after gastric bypass surgery but is unlikely after gastric band or gastric sleeve surgery.

What are the risks of surgery?

People who are very
overweight are more likely than other people to have problems from any kind of
surgery.

There can be a leak from the stomach into the
belly area, which can cause an infection called
peritonitis.

After adjustable gastric banding

You are more likely to need another surgery to fix complications than you would be after gastric bypass. For example, some patients need a second operation because the band slips or it works its way from the outside of the
stomach to the inside. This complication is called an erosion.

You won't lose weight as fast as you
would with gastric bypass.

Surgery has another risk: even though it helps you
lose weight, after a few years you may gain the weight back if you don't follow the changes in your eating and lifestyle.

Weight-loss surgery is not cosmetic surgery. It will not remove fatty tissue. And after a lot of weight loss, you may have excess skin. Some people choose to have more surgery to remove skin from the belly, thighs, upper arms, or breasts.

Why might your doctor recommend surgery?

Your
doctor may recommend weight-loss surgery if:

Your BMI is at least 40 (or your BMI is at least 35 and you have other
health problems related to your weight, such as type 2 diabetes that is difficult to control with diet, exercise, and medicine).

You have tried
for at least 6 months to lose weight with diet and exercise.

You do
not abuse alcohol.

You do not have untreated depression or another
major mental illness.

2. Compare your options

Have weight-loss surgery

Don't have surgery

What is usually involved?

You are asleep during
the operation.

You stay in the hospital one or more
days.

You return to normal activities within 2 to 5 weeks.

You keep trying to lose
weight with healthy eating and exercise.

You may try prescription drugs to help you lose weight.

What are the benefits?

Weight-loss surgery
helps most people lose a lot of weight.

If you lose weight, you're less likely to have
related health problems. And if you already have these health problems, some may get better. Examples are:

General
problems that can occur after surgery include blood clots in the lung and
infection.

Many people have nutrition problems because they eat so little.
That can lead to
anemia or
weak bones.

In people who do not follow the changes in eating and lifestyle, weight gain is much more likely.

There is a risk of death.

If you don't
lose weight, you are more likely to have
related health problems, including
heart disease and
type 2 diabetes.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about having surgery for obesity

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"Weight never used to be a problem for me. But then I had some problems in life and started gaining weight. I tried to lose weight but my problems kept getting in the way. I looked into surgery, but it seemed like a last resort. Instead, I'm working through my problems and feel I can get back to my old weight through less drastic means."

— Charlene, age 52

"I'm pretty young, but my doctor is worried about my weight problem. I guess my BMI and waist size put me at high risk for complications, especially type 2 diabetes. I've tried diet and medicines, but have not had any luck. My doctor is now talking to me about a gastric bypass, and I'm going to give it a try. I need to lose the weight, and feel I can live with the side effects and risks of surgery."

— Mike, age 35

"I know I'm obese and that I'm at risk for health problems. But to me, the risk of surgery and side effects are as bad as being obese, especially at my age. I might try diet or medicine again, but who knows? I'm happy with who I am and lead a good life. Surgery might make it worse. It's not for me."

— Melissa, age 60

"I'm tired of being fat. I've had a weight problem since I was a kid and want something different. Diets, drugs, exercise—I've tried them all. I've been talking to my doctor about surgery. We both feel that reducing my risk of heart problems, plus feeling better about myself, is worth the risks of surgery. The surgery sounds effective, and I feel if I can get started, I'll do fine on my own."

— Frank, age
48

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose weight-loss surgery

Reasons not to choose weight-loss surgery

I have tried diet, exercise, and medicine, and they haven't worked.

I want to keep trying diet, exercise, and medicine to lose weight.

More important

Equally important

More important

My weight bothers me so much that I am willing to have surgery, even though there are risks involved.

My weight doesn't bother me enough to take on the risks of surgery.

More important

Equally important

More important

I feel confident that I can make major diet and exercise changes after surgery.

I'm not sure I can handle the diet and exercise changes I'll need to make after surgery.

More important

Equally important

More important

I'm not worried about paying for this surgery.

I don't think I can afford to pay for this surgery.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
After weight-loss surgery, I will be able to eat normal amounts of food.

True

False

I'm not sure

Correct. Surgery will make your stomach much smaller than normal, so you will need to eat very small amounts of food and pay very close attention to getting the right amounts of vitamins and minerals.

2.
Having weight-loss surgery can cause problems, but my being very overweight can also cause health problems.

True

False

I'm not sure

That's right. Surgery has risks, including a risk of death. But being very overweight can lead to serious health problems, such as heart disease and type 2 diabetes. You need to compare the risks of being obese with the risks of surgery.

3.
Surgery may be an option for me because my BMI is higher than 40.

True

False

I'm not sure

You're right. Surgery is for people who are so heavy that their health is in danger. Those are people whose BMI is at least 40, or at least 35 if they already have other health problems.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

Credits

By

Healthwise Staff

Primary Medical Reviewer

E. Gregory Thompson, MD - Internal Medicine

Specialist Medical Reviewer

Ali Tavakkoli, FACS, FRCS, MD - General Surgery, Bariatric Surgery

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